Healthcare Provider Details

I. General information

NPI: 1477808459
Provider Name (Legal Business Name): THE PENNSYLVANIA HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA HEALTH SYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W WASHINGTON SQ FARM JOURNAL BUILDING, 4TH FLOOR
PHILADELPHIA PA
19106-3500
US

IV. Provider business mailing address

230 W WASHINGTON SQ FARM JOURNAL BUILDING, 4TH FLOOR
PHILADELPHIA PA
19106-3500
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-3561
  • Fax:
Mailing address:
  • Phone: 215-829-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MCCORMICK SR.
Title or Position: AVP
Credential:
Phone: 215-762-0888